The morning rounds at Modogashe hospital in Lagdera do not take long. Most of the rooms opening on to its narrow hallway are empty. “We don’t get that many patients these days,” says Saveria Njoki, the head of nursing. Only three patients were on the ward that day, and none would be staying very long.
According to a local official, patient numbers in Lagdera – a district in Garissa County, in the east of Kenya – have dropped from nearly 12,000 in 2019 to just over 8,000 last year, as people move away in search of water.
Kenya, Ethiopia and Somalia are experiencing their worst drought in 40 years, with their sixth consecutive failed rainy season. The number of people in Kenya facing severe hunger is expected to rise to 5.4 million this year, particularly in the north of the country, where about 95% of surface water sources have dried up. Garissa County is among the worst-hit regions and hordes of people have moved from the countryside to Garissa town, which sits on the Tana River.
Water has always been a problem at Modogashe hospital, which is located along a dusty, windy road. But the situation has got much worse over the past three years as the nearby rivers that provided it with some water have dried up. It is now reliant on water being delivered by road – which can be infrequent because there are not enough trucks.
Lack of water and electricity has already forced the hospital to close its operating theatre and neonatal unit.
Usuba Hussein, 20, brought her baby to the hospital because she was malnourished. Hussein fetches a 20-litre barrel of water from the hospital storage tank and uses her feet to shuffle it back to the ward. “This water needs to last me and my baby for four days,” she says. That includes drinking and washing.
“Things have gone from bad to worse,” says Njoki. “I stay because it’s very difficult to move elsewhere when you’re employed by the government, so I can only wait for retirement.”
In the maternity ward, Athar Khalif, 22, lies on a bed recovering. She gave birth to her daughter on her way here. She wanted to be at the hospital because she bled heavily last time she had a baby and needed to be near trained medics. But she had to wait for a water truck to arrive at home. Women giving birth at Modogashe hospital usually bring a jerrycan of water with them, because the facility will probably not have enough.
In times of extreme water shortages, like now, health workers ask mothers help out. “I was rushing with my children to get water, then I felt some sharp pains. I knew I wouldn’t get to the hospital in time,” says Khalif.
With no water, Njoki has sometimes had to use saline solutions from IV drips to stop infections during deliveries and manage postpartum haemorrhage, the leading cause of maternal deaths. Garissa County has the highest maternal mortality rate in the country: 641 deaths for every 100,000 live births, according to 2019 data by Kenya’s National Bureau of Statistics.
“Put yourself in that situation,” says Njoki. “There’s no water, the mother is bleeding, and you are there and have to do something. Sometimes you have two deliveries without water and a third one on the way. Your only aim is to see the mother and the child alive.”
Mohamed Abdullahi, the chief of Unicef’s Garissa office, says many hospitals in the area are operating under conditions that place patients at risk. “They may be admitted with one issue but pick up an infection while being treated,” he says.
Modogashe has had to cancel some of its critical outreach work because nearly half the community health volunteers who run the programme have left because of drought, leaving the service overstretched.
“Things are really bad,” says Mohammed Sede Dif, 60, a community health worker. “Many [volunteers] have moved to other places. When it rains, they’ll come back, but for now, there’s a big problem. There are so many households that need us and just a few of us left. We receive one call from this side, and another call from the other, so we do what we can but we can’t respond to everything.”
Many of the people who have left the countryside have gone to Garissa town, about 150km (90 miles) south of Lagdera. The town’s three hospitals have reported an increase in patient numbers in recent months, but at least the facilities have underground boreholes, running water and storage facilities – for now.
Unicef said about 3,000 men, women and children have arrived in the town this year from Wajir, another northern region severely affected by the drought. The UN agency estimates that about 80% were unwell or had injuries when they arrived.
“We are now seeing internally displaced people within Kenya for the first time in this crisis,” says Abdullahi. “This is placing an enormous pressure on hospitals in the main towns in drought-affected regions, which are responding to influxes of patients from a widening area.”
At Garissa town’s Iftin hospital, the waiting areas are full and workers bustle around the corridors. A line of patients wait outside the malnutrition centre.
“Resources are getting finished earlier than expected – we are really feeling the pinch,” says Bishar Hassan, the hospital chief. “For now we are able to handle it, but we are concerned that the cases of waterborne diseases may flare up.”
Garissa is still battling a cholera outbreak, which began in October, trigged by the severe drought. The World Health Organization says 7,800 cases have been recorded in the country.
Kenya’s Ministry of Health has launched an oral vaccine campaign to reach 2.2 million people.
Unicef has also rehabilitated 21 boreholes in Garissa and begun prospecting for underground water sources in a number of northern counties. This involves using specialist equipment to more accurately track where water might be found and improve drilling rates.
“The key is to build the capacity of county governments to manage scarce water resources in ways that suit the environment and climate,” says Abdullahi. “The anticipation of future needs is vital.”